What Is A CBO Score? The AHCA’s Fate Depends On It

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On Wednesday afternoon, Congress will know more details about the controversial revised American Health Care Act (AHCA) that recently passed the House. More specifically, the revised AHCA's Congressional Budget Office (CBO) score will be released, providing analysis of the budgetary implications of the health care bill. The new CBO score could vastly impact the fate of the AHCA, as it may play heavily into the development of the Senate healthcare bill and/or require that the House bill be revised and re-voted upon.

The CBO is an independent, nonpartisan entity that specializes in analyzing the budgetary impact of legislation that has been proposed by Congress. A CBO "score" consists of the formal cost estimate of a piece of proposed legislation, which it reveals to the public after extensive careful analysis. The CBO is known and respected for its robust and impartial analysis, which is why its score for proposed legislation is typically so eagerly anticipated.

The version of the AHCA that was passed by the House of Representatives this month does not yet have a CBO score — that comes on Wednesday. However, the CBO did score the original version of the legislation, sans amendments, and revealed some striking information. The CBO found that the original AHCA would cause 24 million Americans to lose health insurance within 10 years, with 14 million of them losing insurance within the first year after the implementation of the AHCA. The AHCA was also estimated to reduce the federal deficit by $337 billion over 10 years.

Now, Congress is waiting to see how much the changes to the version of the AHCA that was ultimately passed (changes which include amendments that allow states to waive certain pre-existing condition protections and those that set aside funds for high risk pools) will affect CBO estimates about deficit savings and the number of uninsured Americans.

According to former Bush administration CBO Director Doug Holtz-Eakin via an interview with The Atlantic, these amendments are likely to be relatively inconsequential in terms of their impact on the new CBO score. Nonetheless, many members of Congress are anxiously awaiting the updated score, as they believe it could have significant ramifications.

First, if the score does not find that the revised AHCA bill saves at least $2 billion over 10 years, Republicans cannot use the budget reconciliation process, which only requires 51 votes, to pass a healthcare bill in the Senate. They would instead need 60 votes. If that's the case, Republicans would have to revise the legislation to reflect these savings and pass it again through the House before it could go to the Senate.

The CBO score will likely help guide the Senate in creating its own healthcare legislation (the Senate will vote on newly-crafted healthcare legislation and not directly vote on that which passed the House). Furthermore, the updated insurance coverage estimates, including how many people stand to lose their insurance under the revised AHCA, will likely strongly impact the way in which the public and many members of Congress respond to the legislation.

Overall, a CBO score is essential to understanding the veritable impact of any proposed legislation, including the revised AHCA. It will be interesting to know the CBO's updated score for this version of the bill, as well as to see if and how this score impacts the trajectory of the accompanying Senate legislation.